Laparoscopic Skills Laboratories: Current Assessment and a Call for Resident Training Standards...
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Transcript of Laparoscopic Skills Laboratories: Current Assessment and a Call for Resident Training Standards...
Laparoscopic Skills Laboratories: Laparoscopic Skills Laboratories: Current Assessment and a Call for Current Assessment and a Call for
Resident Training StandardsResident Training Standards
James R. Korndorffer, Jr., MD, James R. Korndorffer, Jr., MD,
Dimitris Stefanidis, MD, Daniel J. Scott, MDDimitris Stefanidis, MD, Daniel J. Scott, MD
BackgroundBackground
Training in laparoscopic skills laboratories Training in laparoscopic skills laboratories has been shown to transfer to real has been shown to transfer to real operationsoperations1-41-4
Prior study showed 80% of programs had Prior study showed 80% of programs had laparoscopic surgery labslaparoscopic surgery labs55
However, perceived slow adoption to the However, perceived slow adoption to the use of labs in residency training programsuse of labs in residency training programs
1 Korndorffer Jr. JR, et al. Surg Endosc (2005) 19: 161-1672 Seymour NE, et al. Ann Surg (2002) 263: 458 - 4633 Scott DJ, et al. J Am Coll Surg (2000) 191: 272-2834 Fried GM. et al. Surg Endosc (1999) 13: 1077 – 10815 Marks JM, et al. Surg Endosc (2001) 15: 1011-1015
PurposePurpose Believed benefitBelieved benefit of laparoscopic skills labsof laparoscopic skills labs PrevalencePrevalence Composition of the “average lab”Composition of the “average lab”
PurposePurpose““average” skills Labaverage” skills Lab
PurposePurpose
Believed valueBelieved value of laparoscopic skills labsof laparoscopic skills labs
PrevalencePrevalence
Composition of the “average lab”Composition of the “average lab”
UtilizationUtilization
CostsCosts
MethodsMethods
Survey: mailed to all surgical residency Survey: mailed to all surgical residency program directors program directors
Unique identifierUnique identifier
All non-responders contacted by e-mailAll non-responders contacted by e-mail
Remaining no-responders again contacted Remaining no-responders again contacted by mailby mail
MethodsMethods
ResultsResults
64% response rate (162)64% response rate (162) University programs 62%University programs 62% University affiliated/Community 64%University affiliated/Community 64% Community 72%Community 72%
Graduate 647 residents Graduate 647 residents
42 have laparoscopic fellowships42 have laparoscopic fellowships
ResultsResultsPerceivedPerceived ValueValue
Improves OR PerformanceImproves OR Performance Efficient MethodEfficient Method
Recruitment AidRecruitment Aid Have Skills LabsHave Skills Labs
88% 78%
75%55%
ResultsResultsEquipmentEquipment
0%
20%
40%
60%
80%
100%
3.9 / lab (range 1 -15)
ResultsResultsEquipmentEquipment Mirror TypeMirror Type
33% (range 0 - 6)33% (range 0 - 6)
TV TypeTV Type 60% (range 0 - 6)60% (range 0 - 6)
Trainer Box andTrainer Box andLaparoscopeLaparoscope 55% (range 0 - 10)55% (range 0 - 10)
Free StandingFree Standing 31 % (range 0 - 5)31 % (range 0 - 5)
ResultsResultsEquipmentEquipment
0%
20%
40%
60%
80%
100%
3.8 / lab (range 1 - 15)
1.7 / lab (range 1 - 7)
ResultsResultsEquipmentEquipment
MIST-VRMIST-VR 61% (range 0 - 3)61% (range 0 - 3)
EndoscopyEndoscopy 34 % 34 %
OtherOther 37% (range 0 – 3)37% (range 0 – 3)
ResultsResultsUtilization -Utilization - Basic SkillsBasic Skills
0%10%20%30%40%50%60%70%80%90%
100%
Rosse
r/UTSW
ResultsResultsUtilization -Utilization - Basic SkillsBasic Skills
0%10%20%30%40%50%60%70%80%90%
100%
Rosse
r/UTSW
MIS
TELS/FLS
ResultsResultsUtilizationUtilization Basic SkillsBasic Skills
0%10%20%30%40%50%60%70%80%90%
100%
Rosse
r/UTSW
MIS
TELS/FLS
MIS
T_VR
ResultsResultsUtilizationUtilization Basic SkillsBasic Skills
0%10%20%30%40%50%60%70%80%90%
100%
Rosse
r/UTSW
MIS
TELS/FLS
MIS
T-VR
Dept.
Creat
ed
? ?? ?
?
ResultsResultsUtilization -Utilization - SuturingSuturing SkillsSkills
0%10%20%30%40%50%60%70%80%90%
100%
Intra
corp
oreal
Extra
corp
oreal
Endostitc
h
Suture
Ass
ista
nt
"Our o
wn"
?
ResultsResultsUtilization - resident timeUtilization - resident time
Mean time in lab 50 min/weekMean time in lab 50 min/week Range 0 - 5 hrs / wkRange 0 - 5 hrs / wk
48 % less than 1 hr / wk48 % less than 1 hr / wk
Required training 55 % Required training 55 % Range “one session”/ year - 5 hrs/weekRange “one session”/ year - 5 hrs/week
ResultsResultsCostsCosts
StaffingStaffing 1.7 People/lab (range 0 - 5)1.7 People/lab (range 0 - 5)
MD - 79 %MD - 79 % Fellow/resident - 43 %Fellow/resident - 43 % Other - 21 % Other - 21 %
Monetary Monetary Set up $133,000 ($300 - 1 mil)Set up $133,000 ($300 - 1 mil) Annual budget $11,000 ($0 - 50,000)Annual budget $11,000 ($0 - 50,000) Source of FundsSource of Funds
43 % corporate 26 % department 43 % corporate 26 % department
13 % hospital 14 % other13 % hospital 14 % other
3 % government3 % government
SummarySummary
Benefits proven and accepted by mostBenefits proven and accepted by most Small majority have labsSmall majority have labs ““Average Lab”Average Lab”
0.7 mirror trainers0.7 mirror trainers 1.2 TV trainers1.2 TV trainers 1.4 Box Trainers1.4 Box Trainers 0.5 free standing trainers0.5 free standing trainers 0.3 MIST - VR0.3 MIST - VR 0.2 Endoscopic VR0.2 Endoscopic VR 0.3 Other VR0.3 Other VR 0.8 hrs/week0.8 hrs/week 1.7 people for staffing1.7 people for staffing $133.000 set up$133.000 set up
ConclusionConclusion
Impediments to implementationImpediments to implementation What to use and how to use itWhat to use and how to use it
CurriculumCurriculum
Resident motivationResident motivation Program director involvementProgram director involvement
Where to find time in the 80 hr Where to find time in the 80 hr work-weekwork-week
Need to be creativeNeed to be creative AccessibleAccessible
CostsCosts
ConclusionConclusion
Significant variability of equipment and Significant variability of equipment and training practices exist in currently available training practices exist in currently available labs. Strategies are needed for more labs. Strategies are needed for more widespread implementation of skills labs, and widespread implementation of skills labs, and standards should be developed to facilitate standards should be developed to facilitate uniform adoption of validated curricula that uniform adoption of validated curricula that reliably maximize training efficiency and reliably maximize training efficiency and educational benefit. educational benefit.
Laparoscopic Skills Laboratories: Laparoscopic Skills Laboratories: Current Assessment and a Call for Current Assessment and a Call for
Resident Training StandardsResident Training Standards
James R. Korndorffer, Jr., MD, James R. Korndorffer, Jr., MD, Dimitris Stefanidis, MD, Daniel J. Scott, MDDimitris Stefanidis, MD, Daniel J. Scott, MD